This document discusses the importance of prevention and community health. It argues that health is shaped by social and environmental factors like education, income, stress levels, and access to healthy behaviors. Living in poorer communities can expose people to multiple health risks due to lack of resources and opportunities. The document calls for a broader approach to prevention that addresses social determinants of health and empowers communities through partnerships, policies, and initiatives that promote health at individual and environmental levels.

1. Health starts in our
communities: The Prevention
Crisis
Alison Scott, PhD
The College of William and Mary
Department of Kinesiology and Health Sciences
ascott01@wm.edu
Image: NC Community Health Assessment Initiative,
http://www.schs.state.nc.us/SCHS/about/chai.html

2. Roadmap
1. Why a prevention focus?
2. What matters for prevention and health
promotion?
3. What can we do??

3. Health Care Expenditure per Capita
http://www.unnaturalcauses.org/interactivities_04-3.php

4. Life Expectancy at Birth
http://www.unnaturalcauses.org/interactivities_04-1.php

5. ‘Actual causes of death’ (2000)
• Tobacco 18%
• Physical inactivity and poor diet 17%
• Alcohol consumption 4%
• Microbes 3%
• Toxic agents 2%
• Motor vehicles 2%
• Firearms 1%

6. Bad news and good news…
BAD NEWS: We can’t treat our way out of 28th
place.
GOOD NEWS: We can prevent our way out of
28th place.
*Cost-effectively!

7. What matters for prevention and
health promotion?
• Simple!
– Education
– Personal responsibility
– Good behavior choices

8. On average, which of the following conditions is
the strongest predictor of your health?
A. Whether or not you smoke
B. What you eat
C. Whether or not you are wealthy
D. Whether or not you have health
insurance
E. How often you exercise

9. ANSWER:
C. Whether or not you are wealthy
Even if you control for health behaviors.

10. Life Expectancy by Income
82
80.7
80
78.9
78
Life Span
76 76.4
74 74.2
72
<$20K $20-40K $40-80K >$80K
Income Level
Source: National Longitudinal Mortality Study 1988- 1998. Adapted from work prepared for the Robert Wood Johnson Foundation by the Center on Social Disparities in
Health at the University of California, San Francisco; and Norman Johnson, U.S. Bureau of the Census.

11. Life Expectancy by Income and Race
84
82
80
78
Life Span
76
74
72
70
68
<20K White 40-80K >80K
20-40K <20K Black 40-80K >80K
20-40K <20K 20-40K 40-80K >80K
Hispanic

12. September 20, 2012
Life Spans Shrink for Least-Educated
Whites in the U.S.
By SABRINA TAVERNISE
For generations of Americans, it was a given that children would
live longer than their parents. But there is now mounting
evidence that this enduring trend has reversed itself for the
country’s least-educated whites, an increasingly troubled group
whose life expectancy has fallen by four years since 1990.
Researchers have long documented that the most educated
Americans were making the biggest gains in life expectancy, but
now they say mortality data show that life spans for some of the
least educated Americans are actually contracting.
http://www.nytimes.com/2012/09/21/us/life-expectancy-for-less-educated-whites-in-us-is-shrinking.html

13. So…
• Only educated, wealthy, white people make
good health behavior choices?

14. Because…
•Health and healthy choices are shaped by
where we live, work, and play.
• Why living environments matter:
1. Opportunities for healthy behaviors
2. Exposure to chronic stress
3. Social support
US Geological Service,
http://www.cnrfc.noaa.gov/rfc_photo.php?id=crec1&phot
o=upstream

15. 1. Healthy behavior opportunities
• Living environments matter for…
1. Healthy behavior opportunities.

16. • Our neighborhoods.

17. • Our schools and workplaces.

18. 2. ‘Chronic Stress’
• Living environments matter for
– healthy behavior opportunities
– stress exposure
(Cohen, Janicki-Deverts , and Miller 2007; Ader,
Felten, and Cohen 2006)

19. Psychoneuroimmunology
• Studies the interplay of psychology, the nervous
system, and the immune system.
• Findings: Psychosocial stressors can lead to
– impaired immune function
– unregulated inflammation
– hormonal and metabolic imbalances
– via dysregulation of the HPA axis.
• Mind-Body dichotomy artificial
(Cohen, Janicki-Deverts , and Miller 2007; Ader, Felten, and Cohen 2006)

20. • Chronic stress increases disease risk.
–Hypertension
–Heart Disease
–Cancer
–Obesity
–HIV disease progression…

21. • Stress in our neighborhoods?

22. • Stress in our schools and
workplaces?

23. We are especially vulnerable in early life.
– Chronic stress in kids damages the developing brain,
immune system, metabolism.
– Parents’ home ownership can predict immunity to colds as
adults…
– Childhood ACE can double risk of autoimmune disease as
adults…
– Experiences in childhood lay the foundation
for a lifetime of health or illness.
Cohen et al, Dube et al
2009

24. Discrimination is a potent chronic
stressor.
• Race, sex, sexual orientation, size…
• Experiences of lifetime racism are associated
with stress-linked health risks.
– Hypertension
– Obesity
– Depression

25. 3. Social Support
• Living environments matter for:
1. Healthy behavior opportunties
2. Stress
3. Social support

26. 3. Social support
• Being connected to others is
good for our health.
• Emotional
• Instrumental
• Informational
• Supports healthy behaviors
• Increases our resistance to disease
• “tend and befriend”

27. • Happy marriage is good for health
– Longer life, cancer, heart disease,
depression
• Communities have ‘dispositions’ that
matter for health and violence
– Trust, reciprocity, sense of fairness

28. Connecting the dots…
• Resources and education link to:
– Living environments more conducive to
healthy choices
– Fewer chronic stressors
– More social support
– In a gradient.

29. Being poor and uneducated:
A ‘health risk pile-up’
Poor access to healthy foods, substandard housing
and homelessness, low control/ high stress jobs,
lack of sleep, fear of neighborhood violence, higher
density of liquor stores and illegal drug markets,
multiple jobs, poor quality schools, unemployment
and underemployment, lack of recreational
facilities, environmental degradation, lack of
transportation, lack of health insurance, low
educational attainment, lack of bridging social
capital, lack of quality and affordable child care, low
knowledge levels about nutrition and self-care,
inability to buy and prepare healthy meals, lack of
green space, air and noise pollution, lack of
reciprocity and trust, lower instrumental social
support……..
+/- discrimination

30. What can we do?
• Lots!
• A broader frame for action for health.
Work toward communities that….
• catalyze healthy choices
• minimize chronic stress
• support people emotionally and instrumentally

31. Direct Community Action
1. Form partnerships…
– Public Health departments and organizations
2. Assess…
– Challenges
– Capacities
3. Act…
4. Evaluate!

32. Worksite wellness School lunches, food in public
buildings and jails
Fast food-free zones
Smoke-free environments
Community gardens
Enterprise zones
Community summits
on race, class… Build or repair playgrounds
Media campaigns Coalitions to address
Sidewalks environmental
Community center concerns
Transport service or
Job counseling
public transport Peer education
Farmer’s market with EBT Sports teams or clubs

33. Policy Involvement
– Voter awareness and Advocacy
• Health policies
– Clean Air Act
– Prevention and Public Health Fund (ACA)
• Policies and programs that buffer chronic stress and
provide opportunities for healthy choices. These are
health policies too!
•scholarships and loans for education, food support, child care
support, unemployment insurance, universal health coverage,
workplace protections and labor laws, affordable housing, living
wage…
– These are the keys to climbing the health ladder.
– A good investment. $1 trillion productivity losses
each year from chronic illness alone.

34. Conclusions
• The opportunity to be healthy begins at birth, and
continues across the lifespan.
• By embracing the work of primary prevention in our
communities, we can work toward providing all
Americans the opportunity to make healthy choices,
irrespective of income, race, or education.